Multimodal Endovascular Salvage of Catastrophic Extensive Iliofemoral Venous Thrombosis

Burns when extensive are notorious for producing a profound inflammatory stage that often leads to a procoagulable milieu predisposing to deep venous thrombosis (DVT).

A middle-aged man with extensive second-degree burns (30%-40% of total body surface area) after a boiler explosion developed fulminant iliocaval DVT complicated by venous gangrene. A meticulously structured multimodal endovascular approach was employed, integrating thrombolytic therapy (catheter-directed alteplase infusion) with nonthrombolytic modalities (inferior vena cava filter placement, aspiration thrombectomy, and iliac vein stenting). The combined approach facilitated rapid thrombus debulking and restoration of venous patency, resulting in complete limb salvage.

This case underscores the grave yet infrequent complication of extensive DVT after extensive burns, culminating in impending venous gangrene, a condition precipitated by the triad of endothelial injury, venous stasis, and hypercoagulability that is inherent to severe burn pathology.

This case highlights the synergistic interaction between pharmacologic thrombolysis and mechanical interventions, demonstrating their complementary efficacy in optimizing outcomes in extensive, limb-threatening DVT.